title: Percutaneous closure devices do not reduce the risk of major access site complications in patients undergoing elective carotid stent placement.
abstract: OBJECTIVE
  To examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device.
  
  
  METHODS
  A national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006-2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion.
  
  
  RESULTS
  Among 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52%) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2% vs 5.4%; odds ratio = 0.77; 95% confidence interval, 0.55-0.93; P = .0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P = .32), in-hospital mortality (P = .0520), and stroke (P = .31).
  
  
  CONCLUSIONS
  Use of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA. mcdonald.jennifer@mayo.edu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D001803:Blood Transfusion; D002340:Carotid Artery Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D011677:Punctures; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States